Lucky Dog Lodge

Boarding Check in Form

This is NOT a registration. You MUST register by telephone.

Move between fields using the TAB button.

Please fill in this form and either SUBMIT on-line or print and bring in during Check-in. *indicates required fields.

Your Information

*Your Name:

Home Address
*Street:

*City: *State: *Zip:

*Day Phone: *Evening Phone:

E-mail:

Your Veterinarian

*Vet Name:

Practice Name:

*Office Phone: Office Fax:

*After Hours Phone:

*Vet Address (no PO Boxes)
*Street Address:

*City: *State: *Zip:

Emergency Contacts

Please list at least two people who are likely to be able to reach you in the event of an emergency. Furthermore, these people will be authorized to MAKE DECISIONS REGARDING EMERGENCY CARE in the unlikely event you cannot be reached, and/or PICK-UP YOUR PET in the event you are unable to do so. WE CANNOT RELEASE YOUR PET to anyone who is not listed below.

Contact Number 1:
*Name:

*Day Phone: *Evening Phone:

Contact Number 2:
*Name:

*Day Phone: *Evening Phone:

Contact Number 3:
*Name:

*Day Phone: *Evening Phone:

Contact Number 4:
*Name:

*Day Phone: *Evening Phone:

PET INFORMATION-submit one for each pet


*Pet's Name:

*Breed: *Color(s):

*Approx date of Birth: *Sex:

*Spayed/neutered? Yes No

Medical Conditions & Health Record:

Conditions or Health Concerns:

Prescriptions:
Schedule:

Allergies:

Digestive or elimination habits or problems we should be aware of:

If your pet does not reside in Illinois, we will require a health certificate from your veterinarian upon check-in.

*Immunizations
We require WRITTEN PROOF of the following vaccinations at check in time.

 
Date Given
DOGS & CATS
RABIES
DISTEMPER
DOGS ONLY
BORDATELLA
HEPATITIS
PARAINFLUENZA
PARVOVIRUS
Corona Virus (*)
Leptospirosis (*)
Lyme Disease (*)
CATS ONLY
Feline Luekemia (*)
FIP (*)
*Recommended but not required

*PERSONALITY

Please answer the following questions about your pet. Honest answers will help us to understand and care for your pet, as well as protect our staff.

Please describe your pet using the following table, where 1 is NOT AT ALL, and 9 is QUITE A LOT. Check the box that best describes your answer.

DOGS & CATS
Not at All

Some
what
Medium
A Lot
Quite a Lot
Don't Know
1
2
3
4
5
6
7
8
9

Possessiveness
toward food, toys
treats

Aggression towards strangers
Normally Barks/talks
Enjoys eating
Generally fearful or timid
Normal activity level
Likes being brushed
DOGS ONLY
Aggression towards other dogs
Obeys basic commands
CATS ONLY
Likes other Cats
Plays with Toys

Is your pet especially afraid of anything (such as thunderstorms)? Yes No N/A
If so, what?

Is there any place on your pet's body that he/she does NOT like to be touched or petted? Yes No N/A
If so, where?

Is there any place on your pet's body that he/she especially LOVES to be touched or petted? (other than ALL OVER)! Yes No N/A
If so, where?

Does your pet have any peculiar habits? Yes No N/A
If so, what?

Please fill in the following section for DOGS only:

Has your dog every bitten someone? Yes No N/A

If yes, please explain the circumstances:

Does your dog know any basic commands or tricks? Yes No N/A
If yes, please list:

Is there anything else you would like us to know?

If you are boarding more than one dog, please submit, hit the back button and fill in again with second and subsequent dog info. When you come to check in, please come prepared with your itinerary and contact information, as well as your vaccination records.